The Live Active Online Referral Form B is intended for patients WITH established heart disease.
The referring health professional should complete this form. Please ensure the patient meets the referral criteria and the form is fully complete, otherwise they will not be accepted into the service. If patient does not have established heart disease, please use Referral Form A.
This form allows access to medical screening to determine the safety of exercise prescription for the patient.
*These forms will only work when using the latest web browsers, such as Google Chrome, Microsoft Edge or Mozilla Firefox. They will not work when using Internet Explorer.*